Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Dec 2015
Superobesity (body mass index >50 kg/m(2)) and complications after total shoulder arthroplasty: an incremental effect of increasing body mass index.
The prevalence of obesity in the United States continues to increase. Attention has recently turned to an emerging population of extremely overweight patients, termed superobese and defined as those with body mass index (BMI) ≥50 kg/m(2). The goal of this study was to use a national database to evaluate postoperative complication rates after total shoulder arthroplasty (TSA) in superobese patients and to compare patients of different BMI classes. ⋯ Obesity is associated with significantly increased rates of numerous complications after TSA, including infection, dislocation, component loosening, revision surgery, venous thromboembolism, and medical complications, compared with nonobese controls. Superobesity (BMI > 50 kg/m(2)) is associated with significantly increased rates of several complications compared with even obese and morbidly obese patients, including infection, component loosening, venous thromboembolism, and medical complications.
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J Shoulder Elbow Surg · Dec 2015
Randomized Controlled TrialScrew augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures.
Shear forces at the bone-implant interface lead to a loss of reduction after locking plate fixation of proximal humeral fractures. The aim of the study was to analyze the roles of medial support screws and screw augmentation in failure loads and motion at the bone-implant interface after locking plate fixation of proximal humeral fractures. ⋯ The addition of bone cement to augment anteriorly directed head screws does not increase stiffness and failure loads but reduces motion at the bone-implant interface. Thus, the risk of secondary dislocation of the head fragment may be reduced.
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J Shoulder Elbow Surg · Nov 2015
Is minimally invasive plating osteosynthesis for humeral shaft fracture advantageous compared with the conventional open technique?
The minimally invasive plate osteosynthesis (MIPO) technique has been described and used effectively in humeral shaft fractures. However, the postoperative deformity resulting from malreduction with the minimally invasive technique has not received adequate attention. The purpose of this study was to evaluate the postoperative malrotation and the functional results of the MIPO technique and conventional plating in open reduction and internal fixation after humeral shaft fracture. ⋯ The MIPO technique might be advantageous as a cosmetic consideration; however, it did not improve postoperative function and strength restoration results more than the open technique. Moreover, MIPO was associated with greater postoperative malrotation, which was considered to be correlated with subsequent long-term shoulder degeneration.
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J Shoulder Elbow Surg · Nov 2015
Randomized Controlled TrialNeer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty.
Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to significantly reduce blood loss and transfusion requirements after total knee and hip arthroplasty. The purpose of this study was to evaluate the effect of TXA on postoperative blood loss after shoulder arthroplasty. ⋯ In this cohort of patients, those treated with TXA experienced a significantly lower amount of postoperative blood loss and a significantly smaller change in hemoglobin level compared with those treated with placebo. Further work is required to determine the effectiveness and clinical significance of TXA in reducing transfusion requirements in shoulder arthroplasty and, more specifically, shoulder arthroplasty performed for complicated patients or for trauma and fracture patients.
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Nonoperative treatment of displaced medial clavicle fractures often leads to poor functional outcomes and painful nonunions. This study investigates the functional outcomes of patients undergoing operative fixation of these fractures. ⋯ Operative fixation of displaced medial clavicle fractures results in anatomic reconstruction and excellent functional outcomes, even in the setting of fixation performed for symptomatic nonunion. Early intervention can minimize the risk of painful nonunion.